Review of the assessment and management of neonatal abstinence syndrome
Neonatal abstinence syndrome (NAS) secondary to in-utero opioid exposure is an increasing problem. Variability in assessment and treatment of NAS has been attributed to the lack of high-quality evidence to guide management of exposed neonates. This systematic review examines available evidence for N...
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| Veröffentlicht in: | Addiction science & clinical practice 2014-09, Vol.9 (1), p.19-19, Article 19 |
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| creator | Bagley, Sarah Mary Wachman, Elisha M Holland, Erica Brogly, Susan B |
| description | Neonatal abstinence syndrome (NAS) secondary to in-utero opioid exposure is an increasing problem. Variability in assessment and treatment of NAS has been attributed to the lack of high-quality evidence to guide management of exposed neonates. This systematic review examines available evidence for NAS assessment tools, nonpharmacologic interventions, and pharmacologic management of opioid-exposed infants. There is limited data on the inter-observer reliability of NAS assessment tools due to lack of a standardized approach. In addition, most scales were developed prior to the prevalent use of prescribed prenatal concomitant medications, which can complicate NAS assessment. Nonpharmacologic interventions, particularly breastfeeding, may decrease NAS severity. Opioid medications such as morphine or methadone are recommended as first-line therapy, with phenobarbital or clonidine as second-line adjunctive therapy. Further research is needed to determine best practices for assessment, nonpharmacologic intervention, and pharmacologic management of infants with NAS in order to improve outcomes. |
| doi_str_mv | 10.1186/1940-0640-9-19 |
| format | Article |
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Variability in assessment and treatment of NAS has been attributed to the lack of high-quality evidence to guide management of exposed neonates. This systematic review examines available evidence for NAS assessment tools, nonpharmacologic interventions, and pharmacologic management of opioid-exposed infants. There is limited data on the inter-observer reliability of NAS assessment tools due to lack of a standardized approach. In addition, most scales were developed prior to the prevalent use of prescribed prenatal concomitant medications, which can complicate NAS assessment. Nonpharmacologic interventions, particularly breastfeeding, may decrease NAS severity. Opioid medications such as morphine or methadone are recommended as first-line therapy, with phenobarbital or clonidine as second-line adjunctive therapy. Further research is needed to determine best practices for assessment, nonpharmacologic intervention, and pharmacologic management of infants with NAS in order to improve outcomes.</description><identifier>ISSN: 1940-0640</identifier><identifier>ISSN: 1940-0632</identifier><identifier>EISSN: 1940-0640</identifier><identifier>DOI: 10.1186/1940-0640-9-19</identifier><identifier>PMID: 25199822</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Breast Feeding ; Buprenorphine - therapeutic use ; Clonidine - therapeutic use ; Female ; Humans ; Infant, Newborn ; Methadone - therapeutic use ; Narcotics - adverse effects ; Neonatal Abstinence Syndrome - diagnosis ; Neonatal Abstinence Syndrome - therapy ; Opiate Substitution Treatment - methods ; Pregnancy ; Pregnancy Complications - diagnosis ; Pregnancy Complications - therapy ; Prenatal Exposure Delayed Effects - diagnosis ; Prenatal Exposure Delayed Effects - therapy ; Review</subject><ispartof>Addiction science & clinical practice, 2014-09, Vol.9 (1), p.19-19, Article 19</ispartof><rights>Copyright © 2014 Bagley et al.; licensee BioMed Central Ltd. 2014 Bagley et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b448t-631ac8bf8c19d6add79e069d4750a3c4dbc0a95a4579921c98274465450a8b13</citedby><cites>FETCH-LOGICAL-b448t-631ac8bf8c19d6add79e069d4750a3c4dbc0a95a4579921c98274465450a8b13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166410/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166410/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25199822$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bagley, Sarah Mary</creatorcontrib><creatorcontrib>Wachman, Elisha M</creatorcontrib><creatorcontrib>Holland, Erica</creatorcontrib><creatorcontrib>Brogly, Susan B</creatorcontrib><title>Review of the assessment and management of neonatal abstinence syndrome</title><title>Addiction science & clinical practice</title><addtitle>Addict Sci Clin Pract</addtitle><description>Neonatal abstinence syndrome (NAS) secondary to in-utero opioid exposure is an increasing problem. Variability in assessment and treatment of NAS has been attributed to the lack of high-quality evidence to guide management of exposed neonates. This systematic review examines available evidence for NAS assessment tools, nonpharmacologic interventions, and pharmacologic management of opioid-exposed infants. There is limited data on the inter-observer reliability of NAS assessment tools due to lack of a standardized approach. In addition, most scales were developed prior to the prevalent use of prescribed prenatal concomitant medications, which can complicate NAS assessment. Nonpharmacologic interventions, particularly breastfeeding, may decrease NAS severity. Opioid medications such as morphine or methadone are recommended as first-line therapy, with phenobarbital or clonidine as second-line adjunctive therapy. Further research is needed to determine best practices for assessment, nonpharmacologic intervention, and pharmacologic management of infants with NAS in order to improve outcomes.</description><subject>Breast Feeding</subject><subject>Buprenorphine - therapeutic use</subject><subject>Clonidine - therapeutic use</subject><subject>Female</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Methadone - therapeutic use</subject><subject>Narcotics - adverse effects</subject><subject>Neonatal Abstinence Syndrome - diagnosis</subject><subject>Neonatal Abstinence Syndrome - therapy</subject><subject>Opiate Substitution Treatment - methods</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - diagnosis</subject><subject>Pregnancy Complications - therapy</subject><subject>Prenatal Exposure Delayed Effects - diagnosis</subject><subject>Prenatal Exposure Delayed Effects - therapy</subject><subject>Review</subject><issn>1940-0640</issn><issn>1940-0632</issn><issn>1940-0640</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kd9LwzAQx4Mobk5ffZT-A51Jm6bJizCGTmEgyN7D5Ue3ypqMpk7235s6HRviy90l37sPX-4QuiV4TAhn90RQnGIWg0iJOEPDw8f5UT1AVyG8Y8wKUfBLNMgKIgTPsiGavdltbT8TXyXdyiYQgg2hsa5LwJmkAQdL-_2MDc56Bx2sE1Chq5112iZh50zrG3uNLipYB3vzk0do8fS4mD6n89fZy3QyTxWlvEtZTkBzVXFNhGFgTCksZsLQssCQa2qUxiAKoEUpREZ0NFlSygoaZa5IPkIPe-zmQzXW6OishbXctHUD7U56qOWp4uqVXPqtpIQxSnAETPYAVft_AKeK9o3s9yj7PUoR68gY7xm69SG0tjqMEyz7q_wduDt2fWj_PUP-BS-eidU</recordid><startdate>20140909</startdate><enddate>20140909</enddate><creator>Bagley, Sarah Mary</creator><creator>Wachman, Elisha M</creator><creator>Holland, Erica</creator><creator>Brogly, Susan B</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20140909</creationdate><title>Review of the assessment and management of neonatal abstinence syndrome</title><author>Bagley, Sarah Mary ; Wachman, Elisha M ; Holland, Erica ; Brogly, Susan B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b448t-631ac8bf8c19d6add79e069d4750a3c4dbc0a95a4579921c98274465450a8b13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Breast Feeding</topic><topic>Buprenorphine - therapeutic use</topic><topic>Clonidine - therapeutic use</topic><topic>Female</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Methadone - therapeutic use</topic><topic>Narcotics - adverse effects</topic><topic>Neonatal Abstinence Syndrome - diagnosis</topic><topic>Neonatal Abstinence Syndrome - therapy</topic><topic>Opiate Substitution Treatment - methods</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - diagnosis</topic><topic>Pregnancy Complications - therapy</topic><topic>Prenatal Exposure Delayed Effects - diagnosis</topic><topic>Prenatal Exposure Delayed Effects - therapy</topic><topic>Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bagley, Sarah Mary</creatorcontrib><creatorcontrib>Wachman, Elisha M</creatorcontrib><creatorcontrib>Holland, Erica</creatorcontrib><creatorcontrib>Brogly, Susan B</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Addiction science & clinical practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bagley, Sarah Mary</au><au>Wachman, Elisha M</au><au>Holland, Erica</au><au>Brogly, Susan B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Review of the assessment and management of neonatal abstinence syndrome</atitle><jtitle>Addiction science & clinical practice</jtitle><addtitle>Addict Sci Clin Pract</addtitle><date>2014-09-09</date><risdate>2014</risdate><volume>9</volume><issue>1</issue><spage>19</spage><epage>19</epage><pages>19-19</pages><artnum>19</artnum><issn>1940-0640</issn><issn>1940-0632</issn><eissn>1940-0640</eissn><abstract>Neonatal abstinence syndrome (NAS) secondary to in-utero opioid exposure is an increasing problem. Variability in assessment and treatment of NAS has been attributed to the lack of high-quality evidence to guide management of exposed neonates. This systematic review examines available evidence for NAS assessment tools, nonpharmacologic interventions, and pharmacologic management of opioid-exposed infants. There is limited data on the inter-observer reliability of NAS assessment tools due to lack of a standardized approach. In addition, most scales were developed prior to the prevalent use of prescribed prenatal concomitant medications, which can complicate NAS assessment. Nonpharmacologic interventions, particularly breastfeeding, may decrease NAS severity. Opioid medications such as morphine or methadone are recommended as first-line therapy, with phenobarbital or clonidine as second-line adjunctive therapy. Further research is needed to determine best practices for assessment, nonpharmacologic intervention, and pharmacologic management of infants with NAS in order to improve outcomes.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>25199822</pmid><doi>10.1186/1940-0640-9-19</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | U.S. Government Documents; MEDLINE; Springer Nature - Complete Springer Journals; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access; Springer Nature OA Free Journals |
| subjects | Breast Feeding Buprenorphine - therapeutic use Clonidine - therapeutic use Female Humans Infant, Newborn Methadone - therapeutic use Narcotics - adverse effects Neonatal Abstinence Syndrome - diagnosis Neonatal Abstinence Syndrome - therapy Opiate Substitution Treatment - methods Pregnancy Pregnancy Complications - diagnosis Pregnancy Complications - therapy Prenatal Exposure Delayed Effects - diagnosis Prenatal Exposure Delayed Effects - therapy Review |
| title | Review of the assessment and management of neonatal abstinence syndrome |
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